Bill to Delay ICD-10 and Sustainable Growth Rate Patch Passes House

Advocates on behalf of hospitals and practitioners were optimistic about the likelihood of a permanent 'fix' to the Sustainable Growth Rate for Medicare's physician reimbursement system. Members in both the House and the Senate introduced bills this session that would repeal the Sustainable Growth Rate in Medicare's physician payment formula. 

In a surprise development today the House passed the Protecting Access to Medicare Act of 2014, H.R. 4302, by voice vote. This bill does not provide a permanent fix, only a one year patch to the Sustainable Growth Rate. The legislation, sponsored by Rep. Pitts of Pennsylvania, did not extend a fix for the SGR to physician-owned hospitals. Insiders agree that the cost of longer term bipartisan bills with permanent fixes to SGR were tabled because the parties were not able to agree on how to pay for the costs--about $140 billion over a 10 year period.  

Many on the hill expect the Senate to move this bill to a vote tonight. Speaker Harry Reid is said to be working on a deal to bring the bill to the floor. However, Senator Wyden is said to be pushing back on passing a bill with only a short term fix. Stakeholders following SGR legislation believe that if a temporary fix is passed the Congress will feel less pressure, and efforts to pass a permanent fix this year will fade into the background. 

The Protecting Access to Medicare Act of 2014 also contains a provision to delay the ICD-10 meaningful use requirements until October 2015. CMS Administrator Marilyn Tavenner has repeatedly stated that the agency was not going to extend the ICD-10 meaningful use requirements. Many eligible practitioners and hospitals are concerned about being able to meet the deadline and have publicly appealed to the agency and Congress to extend the compliance deadline. 

Patients in ER With Non-Emergency Problems Being Charged Up Front

An article from Kaiser Health News reveals that hospitals are beginning to charge up front those patients who show up at the emergency room with non-emergency issues as a way to reduce costs and ensure that care isn't diverted away from treating true emergencies.

Emergency care physicians and consumer groups worry the policy -- now in place at about half of the nation's emergency rooms -- will scare off patients with true emergencies from seeking ER care.

Click here to read the article.

Source: Kaiser Health News

Study: Health IT May Not Save Costs

Research recently published in the Journal of Health Affairs concludes that giving physicians electronic access to patient's health information does not deter them from ordering tests, and in fact, may encourage doctors to order even more tests.

The study, Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests, was led by Harvard Medical School Assistant Professor of Medicine Danny McCormick, MD.

“Our research raises real concerns about whether health information technology is going to be the answer to reducing costs,” Dr. McCormick told the New York Times.

Source: New York Times article

Doctors Are Cautious, Patients Enthusiastic About Sharing Medical Notes

Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests.

In a study published in the Dec. 20 issue of the Annals of Internal Medicine, patient and doctor attitudes were surveyed extensively prior to the launch of the OpenNotes trial in which patients at BIDMC, Geisinger Health System of Danville, PA, and Harborview Medical Center in Seattle were offered online access to their doctors’ notes written after office visits. Such notes have long been primarily within the doctors’ domain, even though patients have the legal right to obtain them.

"Doctors were divided in many of their expectations, and the issues we highlight have important consequences for both their work life and quality of care," writes lead author Jan Walker, RN, MBA, of BIDMC’s Division of General Medicine and Primary Care.

While many of the more than 100 primary care doctors who volunteered to participate in this experiment predicted possible health benefits from allowing patients to read their notes, the majority of those who declined participation were doubtful about positive impacts. And among the 173 doctors completing surveys, the majority expressed concerns about confusing or worrying patients with the content. Doctors also anticipated that they would write their notes less candidly and that responding to patient questions might be exceedingly time-consuming.
In contrast to the doctors surveyed, the nearly 38,000 patients who completed the baseline survey were almost uniformly optimistic about OpenNotes, and few anticipated being confused or worried

"The enthusiasm of patients exceeded our expectations," wrote Walker. "Most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics."

More than 90 percent favored making the notes available. Well over half anticipated improved adherence to their medications, 90 percent expected to feel more in control of their care, and four out of five predicted they would take better care of themselves.

"We know a lot more about our cars than our own bodies," responded one patient. "We leave all of that to the clinicians. I think by having access to our notes, we can take control, and that’s important."

In addition, half of patients surveyed reported that they would consider sharing their notes with other people, including other doctors.

"As I help my aging mother with her medical needs, I wish I could see the notes her doctors have made," wrote one patient. "I think it would help me in caring for her."

In an accompanying editorial, Thomas W. Feeley, MD, of the MD Anderson Cancer, and Kenneth I. Shine, MD, of the University of Texas, urged that electronic health records be used to engage participants in all parts of the health care delivery system.

"Expanding who uses the records and how they use them promises to facilitate communication, decrease redundant testing, and enhance our care delivery in ways we have yet to imagine."

The year-long OpenNotes study period has now ended, and Walker and her colleagues in the three diverse sites are eager to learn how the baseline expectations will play out. They are currently evaluating reports from follow-up surveys completed by participating doctors and patients and analyzing other metrics, such as how often patients reviewed their notes, shared them with others, or corrected errors their doctors may have made.

"They said they wanted the notes. They said they’d use them, but we have no idea if they actually went online and read them," said Walker. "And if they did read them, we don’t know yet what impact that had on the patients or the doctors."

"Patients want to look into the doctor’s black box, and many doctors are a bit nervous about what they’ll find," said Tom Delbanco, MD, senior author and co-principal investigator of OpenNotes. "But I expect that over time everyone will benefit enormously from such transparency."

"While OpenNotes represents a simple change of practice, the effect on the patient-doctor relationship could be profound. The fact that there’s such a gap between how most patients and many doctors expect that patients will handle the information contained in these notes hints at just how profound that effect might be," added Steve Downs, Robert Wood Johnson Foundation’s Chief Technology and Information Officer. In addition to Walker and Delbanco, the study’s co-authors include: Henry Feldman, MD and Long Ngo, PhD, BIDMC; Suzanne G. Leveille, PhD, RN, University of Massachusetts Boston; Jonathan D. Darer, MD, MPH, Marc J. Lichtenfeld, PhD, Geisinger Health System, Pennsylvania; Shireesha Dhanireddy, MD, Joann G. Elmore, MD, MPH, Natalia Oster, MPH, Elisabeth Vodicka, BA; Harborview Medical Center, Seattle; James D. Ralston, MD, MPH, Group Health Research Institute, Seattle; and Stephen E. Ross, MD, University of Colorado Health Sciences Center.

Source: OpenNotes Press Release

New HHS Regs Streamline Health Electronic Funds Transfer; Cut Red Tape

New standards for electronic funds transfers in health care, required by the Affordable Care Act, will reduce up to $4.5 billion off administrative costs for doctors and hospitals, private health plans, states, and other government health plans, over the next ten years, according to estimates included in new rules published by the U.S. Department of Health and Human Services (HHS).

The standards build upon regulations published in 2011 that set industry-wide standards for how health providers use electronic systems to quickly and easily determine a patient’s eligibility for health coverage and check on the status of a health claim.

Together, the two regulations implementing the Administrative Simplification provisions of the Affordable Care Act and the Health Insurance Portability and Accountability Act (HIPAA) are projected to save the health care industry more than $16 billion over the next 10 years. These savings come from the adoption of electronic standards that will help eliminate inefficient manual processes and reduce costs.

“Thanks to the Affordable Care Act, health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients,” said HHS Secretary Kathleen Sebelius.

A May 2010 study in the journal Health Affairs found that physicians spend nearly 12 percent of every dollar they receive from patients to cover the costs of filling out forms and performing other excessively complex administrative tasks. The study found that simplifying these systems could save four hours per week of professional time per physician and five hours of support staff time every week – time that could be better spent on patient care.

“As a nurse, I know the importance of giving health care professionals time to focus on patient care,” said CMS Acting Administrator Marilyn Tavenner. “The less time a physician has to spend on paperwork is that much more time that can be devoted to patient care. Having standardized procedures across the health care industry can only lead to lower costs and greater efficiencies all around.”

The rule—the Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice — adopts streamlined standards for the format and data content of the transmission a health plan sends to its bank when it wants to pay a claim to a provider electronically (through an electronic funds transfer) and to issue a Remittance Advice notice. Remittance Advice is a notice of payment sent to providers that may or may not accompany the payment the provider receives.

For example, currently when a provider submits a claim electronically for payment, a health plan often sends a Remittance Advice separately from the Electronic Funds Transfers payment. The disconnect between the two makes it difficult or sometimes impossible for the provider to match up the bill and the corresponding payment. The rule addresses this by requiring the use of a trace number that automatically matches the two. The new tracking system will allow health care providers to eliminate costly manual reconciliation that must currently be done.

Future administrative simplification rules will address adoption of:
- A standard unique identifier for health plans;
- A standard for claims attachments; and
- Requirements that health plans certify compliance with all HIPAA standards and operating rules.

The regulation is effective January 1, 2012. All health plans covered under HIPAA must comply by January 1, 2014.

To view the Interim Final Regulation with comment period, go to: http://www.regulations.gov

For more information on the June 2011 HIPAA Administrative regulation: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status, visit: http://www.hhs.gov/news/press/2011pres/06/20110630a.html

Source: HHS News Release

Choosing Wisely Campaign Launches to Help Physicians Better Manage Health Care

Recognizing that patients often ask for tests and treatments that are not necessarily in their best
interest, and physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible bases, the ABIM Foundation has joined with nine leading medical specialty societies to develop evidence-based lists of tests and procedures for patients and physicians to question as part of Choosing Wisely TM.

The goal of the campaign is to help physicians, patients and other health care stakeholders think and talk about overuse or misuse of health care resources in the United States.

Consumer Reports, the nation’s leading expert, independent, nonprofit consumer organization, has also joined the campaign to provide resources for consumers and physicians to engage in these important conversations. The campaign is part of the ABIM Foundation’s goal of promoting wise choices by clinicians in order to improve health care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions and reduce the rapidly-expanding costs of the health care system. The lists of Five Things Physicians and Patients
Should Question is modeled after the successful National Physicians Alliance (NPA) project titled “Five Things You Can Do in Your Practice,” which was funded by the ABIM Foundation in 2009.
As part of Choosing Wisely, each participating specialty society will identify its own list of five common tests or procedures whose use in their profession should be discussed or questioned. The lists will be unveiled in April 2012. The societies were given the following parameters to develop the lists:
- Each item should be within the specialty’s purview and control;
- Procedures should be used frequently and/or carry a significant cost; and
- There needs to be evidence to support each recommendation.

“Physicians play a leading role in addressing problems with our nation’s health care system. That is why the ABIM Foundation is proud to be working with specialty societies that have proactively decided to address some of the most important issues in health care head on,” said Christine K. Cassel, MD, president and CEO of the ABIM Foundation. “By identifying specific procedures or tests that may commonly be ordered, but not always necessary to improving patient care, we’re kicking off an important and overdue conversation about making wise choices in health care. Everyone – providers, patients and others – plays a part in being better stewards of the system’s finite resources.”

The Congressional Budget Office estimates that up to 30 percent of care delivered in America goes toward unnecessary tests, procedures, medical appointments, hospital stays and other services that may not improve people’s health – and in fact may actually cause harm. If current trends remain unchanged, the Centers for Medicare & Medicaid Services project U.S. health care spending will reach $4.3 trillion and account for 19.3 percent of the nation’s gross domestic product by 2019.

First announced in March 2011, Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. It is part of the ABIM Foundation’s long history of advancing medical professionalism and supporting similar initiatives. In 2002 the Foundation, along with the American College of Physicians Foundation and European Federation of Internal Medicine, authored Medical Professionalism in the New Millennium: A Physician Charter. The Physician Charter has as its fundamental principles the primacy of patient welfare, patient autonomy and social justice and articulates professional responsibilities of physicians, including a commitment to improving quality and access to care, advocating for a just and cost-effective distribution of finite resources and maintaining trust by managing conflicts of interest.

To learn more about Choosing Wisely visit www.ChoosingWisely.org.

Source: Choosing Wisely News Release

Timeline for Health Care Reform

According to a recently published timeline for the implementation of the Affordable Care Act (health care reform), in 2012, Affordable Care Organizations will be voluntarily formed by health care providers to assume care for groups of 5000 or more Medicare patients.

The goal of the initiative is to lower the cost of health care without sacrificing quality.

Source: Article in Times Free Press

Patient Engagement Important to Success of Health Care Reform

Kenneth Bertka, MD, recently authored an article about the importance of patient engagement in the success of health care reform. In his article Patient Engagement's Critical Role in Post-Reform Success: 6 Steps to Improve Patient Centeredness, Dr. Bertka says that "[p]atient engagement...is more than a nice thing to do. Engaged patients are more likely to comply with their treatment and prevention plans, which results in higher quality care, fewer medical errors and lower cost."

Read Dr. Bertka's article here.

Source: Becker's Hospital Review

EHR Decision Support Tool Saved Physicians Time, Errors in Retrieving Clinical Information

A decision support tool generated by an electronic health record (EHR) that collects clinical information on ambulatory diabetes care saved primary care physicians more than 4 minutes compared to the conventional method of searching on multiple EHR screens, an AHRQ-funded study has found. Writing in the September/October 2011 issue of the Annals of Family Medicine, researchers at the University of Missouri family medicine department created an EHR-generated diabetes “dashboard” with the technology company Cerner. The dashboard collects important diabetes clinical data on one page and mirrors the information sought by national organizations to benchmark high-quality diabetes care. Physicians using the dashboard located the 10 data elements within 1.3 minutes, compared to 5.5 minutes among physicians searching multiple EHR screens. Physicians who used the dashboard correctly identified the data requested 100 percent of the time, compared to 94 percent for physicians using the conventional method.

Select for the article.

Source: AHRQ News Release

Children's Hospitals Growing; Raises Questions About Spending

A news report by Kaiser Health News says that children's hospitals are growing and this growth spurt has led to questions about spending. The report says that the hospitals have hired lobbyists to obtain ensure special treatment by Congress and ensure that the highest insurance rates are paid to their facilities.

Source: Kaiser Health News Article

Survey: Physicians Say They Over-Treat Patients

A recent survey of physicians conducted by the VA Outcomes Group and the Dartmouth Institute for Health Policy and Clinical Practice reveals that they feel that they are over-treating their patients. Many physicians indicate that this is caused by pressures caused by the fear of malpractice suits, the realignment of financial incentives towards more aggressive treatment, and shortened time to spend with patients.

A report about the survey is published in the September 26 issue of Archives of Internal Medicine.

Source: Dartmouth Institute for Health Policy and Clinical Practice News Release

HHS launches new Affordable Care Act initiative to strengthen primary care

The U.S. Department of Health and Human Services (HHS) launched a new initiative made possible by the Affordable Care Act to help primary care practices deliver higher quality, more coordinated and patient-centered care. Under the new initiative, Medicare will work with commercial and state health insurance plans to offer additional support to primary care doctors who better coordinate care for their patients. This collaboration, known as the Comprehensive Primary Care initiative, is modeled after innovative practices developed by large employers and leading private health insurers in the private sector.

“Thanks to the Affordable Care Act, we are helping primary care doctors better coordinate care with patients so they get better care and we use our health care dollars more wisely,” said HHS Secretary Kathleen Sebelius.

The voluntary initiative will begin as a demonstration project available in five to seven health care markets across the country. Public and private health care payers interested in applying to participate in the Comprehensive Primary Care Initiative must submit a Letter of Intent by November 15, 2011. In the selected markets, Medicare and its partners will enroll interested primary care providers into the initiative.

Primary care practices that choose to participate in this initiative will be given support to better coordinate primary care for their Medicare patients.
This support will help doctors:

• Help patients with serious or chronic diseases follow personalized care plans;
• Give patients 24-hour access to care and health information;
• Deliver preventive care;
• Engage patients and their families in their own care;
• Work together with other doctors, including specialists, to provide better coordinated care.

CMS will pay primary care practices a monthly fee for these activities in addition to the usual Medicare fees that these practices would receive for delivering Medicare covered services. This collaborative approach has the potential to strengthen the primary care system for all Americans and reduce health care costs by using resources more wisely and preventing disease before it happens.

Across the country, systems which are based on comprehensive, higher-functioning primary care, similar to the strategy that CMS seeks to test in this initiative, show that patients are healthier and avoid having to seek care in more complex and expensive settings when primary care practices have the resources to better coordinate care, engage patients in their care plan, and provide timely preventive care. Large businesses have been able to make independent investments to promote more comprehensive primary care – improving the health of their employees and lowering their health care costs, thus making it easier for them to hire more workers and invest in their workforce.

“We know that when doctors have time to spend time with their patients and can better coordinate care with specialists, people are healthier and we have lower costs in the health care system,” said CMS Administrator Donald Berwick, M.D.

The Comprehensive Primary Care initiative is just one part of a wide-ranging effort by the Obama Administration to promote coordinated care and lower costs for all Americans, using important new tools provided by the Affordable Care Act. Accountable Care Organizations (ACOs) are another way that doctors, hospitals and other health care providers can work together to better coordinate care for patients, which can help improve health, improve the quality of care, and lower costs. Under the Bundled Payment initiative, payments for multiple services patients receive during an episode of care will be linked to help improve and coordinate care for patients while they are in the hospital and after they are discharged. The Partnership for Patients is bringing together hospitals, doctors, nurses, pharmacists, employers, unions, and state and federal government to keep patients from getting injured or sicker in the health care system and to improve transitions between care settings.

For more information, please see the Comprehensive Primary Care initiative web site at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/cpci/

For an overview fact sheet about the Comprehensive Primary Care initiative, visit: http://www.healthcare.gov/news/factsheets/2011/09/primary-care09282011a.html

Interested parties may obtain answers to specific questions by e-mailing CMS at: CPCi@cms.hhs.gov.

For more information about the CMS Innovation Center, please visit: http://www.innovations.cms.gov.

Source: HHS News Release

ISMP Medication Safety Self-Assessments Due August 31

The Institute for Safe Medicine Practices (ISMP) is requesting data submissions until August 31, 2011 for their self-assessment for hospitals to use to evaluate their medication safety practices.

Additional information about the assessments is here.

Source: The Joint Commission

New App Gets "Meaningful Use" Certification

A new iPad application called "drchrono" has received ONC-ATCB "meaningful use" certification from the Centers for Medicare and Medicaid's (CMS) Electronic Health Record (EHR) Incentive Programs.

The new application allows speech-to-text, so physicians can forgo transcription of their notes and also has paperless billing and prescription writing functions.

Source: The Washington Post Ideas@Innovations Blog

Study: E-Health Project Boosts Physicians' Ability To Use Patient Registries

The results of a new Agency for Healthcare Research and Quality-funded (AHRQ) study shows that Massachusetts physicians taking part in a 4-year, $50 million health information technology (IT) program increased their ability to generate and use registries that provide information about laboratory test results and medication use.

The ability to use patient registries, or lists of patients with specific conditions, medications or test results, is considered an essential tool for improving health care and is in the “meaningful use” criteria developed by the Centers for Medicare and Medicaid Services.

A total of 163 physicians from 134 practices in 3 communities participated in the health IT program between 2005 through 2009. Sponsored by the Massachusetts eHealth Collaborative, the program consisted of robust electronic health records and work-flow redesign and technical support at no cost to the practices. Compared with all physicians who were surveyed in 2005, all respondents in 2009 were more likely to be able to generate significantly more laboratory and medication registries. The free abstract is available on PubMed at http://www.ncbi.nlm.nih.gov/pubmed/21734198.

Source: AHRQ News Release

"Mystery Shoppers" to Be Used to Survey Doctors

According to a recent report in the New York Times, the U.S. Department of Health and Human Services (HHS) plans to use "mystery shopper" techniques to survey primary care physicians across the country in an effort to determine the difficulty of obtaining care. HHS officials say that surveyors will contact physician's offices and pose as patients to determine how easily they can obtain an appointment. Surveyors will also make note of whether it is easier to obtain an appointment depending upon whether the caller has public or private insurance. HHS officials indicate that the program was modeled on a similar survey conducted by the Bush Administration and that all information is kept confidential.

Source: New York Times article

JCR Announces Upcoming Hospital Executive Briefings

The Joint Commission has announced its schedule of 2012 Hospital Executive Briefings on hospital accreditation and safety. Briefings will take place on September 9, 2011 in New York, September 15, 2011 in Dallas, September 21, 2011 in Costa Mesa, CA, and September 26, 2011 in Chicago. Attendance at the briefings is appropriate for hospital executives, chief nursing officers, risk managers, quality improvement managers, accreditation managers, patient safety officers, chief medical officers, board members, and medical staff members involved with accreditation, quality improvement, and risk management processes in their hospital.

For more information about the briefings, please click here.

Source: The Joint Commission

Drug Companies Challenge Vermont Data Mining Law in Supreme Court

A lawsuit brought by pharmaceutical manufacturers challenging a Vermont law that prohibits the sale of information about the medicines that doctors are prescribing to their patients was argued in the U.S. Supreme Court on April 26.

The Vermont law prohibits the sale of the information without obtaining permission from the doctor first.

Source: http://www.npr.org/templates/story/story.php?storyId=135737160

Study Highlights Primary Care Shortage

A George Washington University study shows that medical schools are continuing to produce more graduates going into research and specialty professions and not enough primary care doctors. The study also found that graduates of public medical schools were more likely to promote a "social mission," encouraging graduates to go into primary care, especially in underserved communities.

Many analysts believe that the continued shortage of graduates entering the primary care field is due to the low reimbursement rate. After graduating with massive debt, graduates are hesitant to select a field that pays an average of $124,000 a year, the lowest rate among physician specialties.

The new health reform law sets aside $1.5 billion in funding for primary care physicians who work in underserved areas. Some hospitals are also working to attract physicians into primary care, fearing that without first-line care, patients will flood their emergency rooms with minor and preventable conditions. This study and others that have been released, continue to serve as indicators that improvments to the delivery of care are needed to support an increased patient population.

The full George Washington study can be found here:http://www.annals.org/content/152/12/804.full?aimhp

21 Percent Physician Reimbursement Cut Delayed

On June 25, President Obama signed The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.

The law cancels a 21 percent physician Medicare reimbursement cut that CMS began enforcing on June 18. The law also increases physician reimbursement by 2.2 percent through November.

The temporary increase is a sign that Congress still needs to take action to address the sustainable growth rate, which factors into the reimbursement rates. There have been estimates that the physician payment cut may reach as high as 30% by January if Congress does not find a long-term solution, or implement another "patch" when the reimbursement increase expires in November.

CMS will begin processing all claims at the new rate by July 1.


Source: BNA